Provider Demographics
NPI:1629455902
Name:LAB C
Entity Type:Organization
Organization Name:LAB C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON-SOBIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-231-5603
Mailing Address - Street 1:500 E TUDOR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7368
Mailing Address - Country:US
Mailing Address - Phone:907-231-5603
Mailing Address - Fax:907-563-5047
Practice Address - Street 1:500 E TUDOR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7368
Practice Address - Country:US
Practice Address - Phone:907-231-5603
Practice Address - Fax:907-563-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1016661291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory